Participación del transporte simplástico de las auxinas durante el desarrollo de las plantas / Symplastic transport participation of auxins during plant development

Resumen: La apropiada organogénesis de las plantas, durante su ciclo de vida, propicia su desarrollo y la adaptación a diferentes condiciones am bientales. Diversas fitohormonas regulan el desarrollo vegetal, pero la auxina denominada ácido indol-3-acético (AIA) es una de las más importantes. El AIA se sintetiza en la parte aérea de la planta y se moviliza a los tejidos demandantes por un transporte rápido que utiliza el floema y por el transporte polar de auxinas (TPA). Recientemente, se ha demostrado que las auxinas también se movilizan mediante el transporte simplástico (TS) a través de los plasmodesmos (PD), cuya apertura o cierre está regulada respectivamente por la degradación o la deposición de la callosa. El objetivo del presente trabajo fue profundizar en los avances sobre la participación del transporte simplástico de las auxinas durante el desarrollo vegetal, así como la degradación o deposición de la callosa, en el cierre o apertura de los PD, para regular el desarrollo de algunos órganos de Arabidopsis thaliana. La intervención de las proteínas PDLP5 es determinante para la deposición de la callosa en los PD, lo que regula la distribución de la auxina e impacta en la formación radicular, especialmente en las raíces laterales. La participación del TS es importante para desarrollar la actividad de las auxinas, lo cual favorece la formación radicular, necesaria en la mejora de absorción de nutrientes de las plantas. Este conocimiento puede ser utilizado para mejorar las plantas de interés agronómico.

Abstract: The appropriate organogenesis of plants during their life cycle promotes their development and adaptation to different environmental conditions. Various phytohormones regulate plant development but auxin, called Indole-3-Acetic Acid (IAA), is one of the most important. IAA is synthesized in the aerial part of plant and is mobilized to the demanding tissues by a rapid transport using the phloem and by the polar auxin transport (PAT). Recently, it has been shown that auxins also are mobilized by a symplastic transport (ST) through plasmodesmata (PD), which opening or closing is regulated by the callose degradation or deposition respectively. The objective of the present work was to deepen the analysis on the participation of symplastic transport of auxins during plant development, as well in the callose degradation or deposition, in the closing or opening of the PD, that regulates the development of some organs of Arabidopsis thaliana. The intervention of PDLP5 proteins is decisive for the callose deposition in the PD, which regulates the auxin distribution and impacts root formation, especially at the lateral roots. The participation of TS is important to develop the auxin activity, which favors root formation, necessary for the improvement plant nutrient absorption. This knowledge can be used to improve development plants of agronomic interest.

Double Myelomeningocele Repair by Fetal Surgery with a Single Micro-Hysterotomy.

INTRODUCTION: Open spina bifida (OSB) is the most common congenital anomaly of the central nervous system. It is associated with severe neurodevelopmental delay, motor impairment, hydrocephalus, and bowel and bladder dysfunction. In selected cases, intrauterine spina bifida repair has been shown to improve neonatal outcomes. Rarely, the spine can have a double defect compromising two different segments and there is a lack of evidence on the feasibility and benefits of intrauterine repair in these cases. CASE PRESENTATION: We present a case with both cervicothoracic and lumbosacral myelomeningocele, Arnold-Chiari malformation type II and bilateral ventriculomegaly, that was treated successfully at 25 weeks with open micro-neurosurgery. Double myelomeningocele was successfully treated through a single 2-cm micro-hysterotomy, by performing external versions to sequentially expose and repair both defects. Weekly postoperative follow-up showed no progression of ventriculomegaly or complications attributable to the procedure. Preterm rupture of membranes prompted a conventional cesarean delivery at 32 weeks of gestation. Neurodevelopmental outcome at 20 months was within normal ranges, having achieved ambulation without orthopedic support and with no need for ventriculoperitoneal shunting. CONCLUSION: This report demonstrates for the first time the feasibility of double OSB repair through a single 2-cm micro-hysterotomy, suggesting that selected isolated cases of double myelomeningocele could be candidates for fetal intervention. Further prospective studies should be carried out to assess the potential benefit of double OSB intrauterine open repair.

Management of Late Twin-to-Twin Transfusion Syndrome beyond 26 Weeks: Comparison between Fetoscopic Laser Therapy versus Traditional Management.

INTRODUCTION: A proportion of monochorionic diamniotic (MCDA) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) can present after 26 weeks of gestation. The aim of this study was to compare perinatal outcomes of late TTTS treated by fetoscopic laser coagulation versus traditional management with amniodrainage and/or emergency preterm cesarean delivery (CD). METHODS: Retrospective cohort from January 2012 to January 2023 of consecutive MCDA twin pregnancies complicated by TTTS after 26 weeks and evaluated in our referring centers. We analyzed perinatal outcomes of cases treated with fetoscopic laser surgery at our national referral fetal surgery center in Queretaro, Mexico, and compared them with those managed with traditional management (amniodrainage and/or emergency preterm CD). The primary outcome was survival at discharge and the secondary outcome was gestational age (GA) at birth. RESULTS: Among the study population, 46 TTTS cases were treated by fetoscopy at 27+6 (26+0-31+0) weeks+days and were compared with a group of 39 cases who underwent emergency preterm CD. In comparison to the group who underwent traditional management, the group treated by laser fetoscopy showed a significantly higher GA at birth (32+3 vs. 29+1 weeks+days, p < 0.001), lower frequency of preterm delivery below 37 weeks (91.3% vs. 100%, p = 0.06), 34 weeks (63.0% vs. 100%, p < 0.001), 32 weeks (50% vs. 74.4%, p = 0.02), or 30 weeks (28.3% vs. 53.8%, p = 0.01), and significantly higher perinatal survival (89.1% vs. 71.8%, p < 0.05 of at least one twin; and 65.2% vs. 38.5%, p = 0.01 of both twins, respectively). CONCLUSION: MCDA twins complicated with TTTS can be treated with fetoscopic laser surgery between 26 and 31 weeks of gestation, which is a feasible and safe option, and such cases are associated with a higher GA at birth and better perinatal survival than those managed with amniodrainage and/or emergency preterm CD.

Universal prenatal screening: a initiative from Guanajuato, Mexico to improve equity in perinatal healthcare.

The prenatal approach from a preventive perspective is necessary to reduce perinatal complications. A perinatal care model with a holistic and horizontal approach is required. Mexico is currently considered an emerging market economy with inequality and an economic gap that impacts the accessibility and distribution of healthcare services. Guanajuato is one of the 32 states of Mexico and represents 1.6% of the country's surface. Strategies during the prenatal approach allow prediction, diagnosis, and anticipation of the principal causes of morbidity and mortality. Combining data from maternal characteristics and history with findings of biophysical and biochemical tests at 11 to 13 weeks of gestation can define the patient-specific risk for a large spectrum of complications that include miscarriage and fetal death, preterm delivery, preeclampsia, congenital disorders, and fetal growth abnormalities. We aim to describe the care model designed and implemented in the State Center for Timely Prenatal Screening of the Maternal and Child Hospital of Leon, Guanajuato, Mexico. Previous research showed there is a lack of information for low and middle-income countries regarding how to integrate prenatal screening strategies in the absence of resources to perform cell-free fetal DNA or biochemical serum markers in countries with emergent economies. This care model is carried out through horizontal processes where the screening is provided by trained and certified general practitioners who identify the population at risk in a timely manner for specialized care, and could help guide other Mexican states, and other countries with emergent economies with limited financial, professional, and infrastructural resources to improve prenatal care with a sense of equity, equality, and social inclusion as well as the timely evaluation of specialized perinatal care of high-risk patients.

Periodontitis necrotizante-diagnóstico y tratamiento. Reporte de caso / Necrotizing periodontitis-diagnosis and treatment. Case report

Introducción: La periodontitis necrotizante (NP) es una enfermedad inflamatoria aguda que puede aparecer de forma repentina y con rápida destrucción de los tejidos periodontales. Los hallazgos clínicos más relevantes son necrosis y úlcera en la papila interdental, sangrado gingival, dolor, destrucción ósea y, en casos severos, puede ocurrir secuestro óseo. Aunque el factor etiológico principal es la acumulación de biofilm bacteriano, los factores de riesgo como las enfermedades sistémicas y/o psicológicas podrían afectar la respuesta inmune del huésped y jugar un papel importante en el desarrollo de NP. Objetivo: Presentar la resolución de un caso de PN con un enfoque multidisciplinario y conservador. Presentación del caso: Paciente de sexo femenino de 22 años que fue remitida al Centro de Clínicas Odontológicas de la Universidad de Talca (Talca, Chile) con aparente estrés psicológico y fumadora. Refiere dolor intenso y persistente en los dientes anteriores con sangrado espontáneo y halitosis durante 2 semanas. El tratamiento consistió en la evaluación de la condición sistémica y el manejo de la fase aguda, la fase etiológica y posterior fase correctiva para la corrección quirúrgica de las secuelas. Este caso tiene 2 años de seguimiento con un riguroso régimen de mantenimiento periodontal, reevaluando los tejidos periodontales, motivando y reforzando la higiene bucal. Conclusiones: Este caso clínico contribuye al diagnóstico y opciones terapéuticas que tiene el profesional ante las secuelas que se presentan en los casos de PN, que, si bien no es una patología frecuente, puede avanzar rápidamente y aumentar el daño tisular. (AU)

Introduction: Necrotizing periodontitis (NP) is an acute inflammatory disease that can appear suddenly and with fast destruction of periodontal tissues. The most relevant clinical findings are necrosis and ulcer at the interdental papilla, gingival bleeding, pain, bone destruction, and, in severe cases, bone sequestrum could occur. Although the primary etiological factor is the accumulation of bacterial biofilm, risk factors like systemic and/or psychological diseases could affect the host immune response playing an important role in the development of NP. Objective: Present the resolution of a PN case with a multidisciplinary and conservative approach. Case presentation: A 22-year-old female patient was referred to the Dental Clinics Center of the University of Talca (Talca, Chile) with apparent psychological stress and smoker. She reports intense and persistent pain in the anterior teeth with spontaneous bleeding and halitosis for 2 weeks.The treatment consisted of the evaluation of the systemic condition and the management of the acute phase, the etiological phase, and subsequent corrective phase for the surgical correction for the sequels. This case has 2 years follow-up with a rigorous periodontal maintenance regimen, re-evaluating the periodontal tissues, motivating, and reinforcing oral hygiene. Conclusions: This case report contributes to the diagnosis and therapeutic options that the professional has in front of the sequels that occur in cases of NP, which, although it is not a frequent pathology, can quickly worsen and increase tissue damage. (AU)

Intrauterine transfusion of a hydropic fetus with anemia due to a giant chorioangioma: A case report.

Giant chorioangiomas are a potentially life-threatening condition that may require intrauterine therapy. We describe a case of a large chorioangioma (>4cm) diagnosed at 30 weeks of gestation causing severe fetal anemia and hydrops. An intrauterine blood transfusion was performed at 31 weeks with reversal of the anemia and hydrops. The neonate was born at 37 weeks showing respiratory distress syndrome that required neonatal intensive care unit admission but was discharged at 30 days of life. Further evaluation at two months of age showed no signs of abnormal neurodevelopment. When timely indicated, intrauterine transfusion of a hydropic fetus with anemia due to a giant chorioangioma is a potentially life-saving therapy that shows good neurodevelopment of the surviving fetus.

Prenatal diagnosis of congenital heart defects: experience of the first Fetal Cardiology Unit in Mexico.

OBJECTIVE: The purpose of this article was to describe our experience with the prenatal diagnosis of CHD in patients referred to our Fetal Cardiology Unit. METHODS: Prospective cohort study of consecutive fetuses referred for advanced fetal echocardiography to our Fetal Cardiology Unit during a 3-year period (September 2015-September 2018). RESULTS: Totally 809 fetuses were evaluated, with 1263 fetal advanced echocardiographies performed. Suspected cardiac abnormality was the most common indication for referral (62.2%). Only 7.3% of patients had known morbidities or risk factors for CHD. Mean gestational age at first examination was 25.6 ± 6.4 weeks. A total of 528 (65.3%) fetuses were found to have a cardiac defect: 40.7% had isolated CHD while 24.6% had associated anomalies. The most common defects found were ventricular septal defects (20.3%), followed by conotruncal defects (9.7%), hypoplastic left heart syndrome (9.3%), fetal arrhythmias (8.9%), and venous anomalies (8.7%). 31.6% presented abnormal genetic studies, the most frequent being Down syndrome (23/212, 10.8%), followed by DiGeorge syndrome (11/212, 5.2%). CONCLUSIONS: Prenatal screening and diagnosis of CHD in Mexico are feasible, with suspected cardiac abnormality being the main reason for referral to a specialized Fetal Cardiology Unit. Efforts must be made to make screening available to the general population in the first and second trimesters of pregnancy by fetal medicine or trained specialists, in order to identify fetal CHD and offer advanced echocardiography, genetic studies, timely fetal cardiac intervention in selected cases, and delivery in tertiary centers, to improve overall survival.

Resistencia de unión de cerámica feldespática a esmalte bovino empleando diferentes cementos resinosos / Resistance to microtensile bond strenght between feldspathic ceramic and bovine tooth enamel using different resin cements

OBJETIVO: Comparar la resistencia de unión de cerámica feldespática al esmalte bovino entre las diferentes marcas de cementos resinosos autoadhesivos y un cemento resinoso dual universal.MATERIALES Y MÉTODOS: Se utilizaron ocho incisivos inferiores sanos de bovino divididos en cuatro grupos. Al grupo del cemento resinoso dual se le realizó un tratamiento previo de ácido ortofosfórico al 37% y adhesivo Single Bond Universal y a los 3 grupos de cementos resinosos autoadhesivos se les realizó un tratamiento previo sólo con ácido ortofosfórico al 37% sobre el esmalte dentario. Grupo I: ICem (Heraus Kulzer), Grupo II: Panavia Cement Automix (Kuraray), Grupo III: Relyx Ultimate (3M-ESPE), GC: Maxcem Elite (Kerr). Los especímenes obtenidos (n=30 por gru-po) se obtuvieron con una máquina tipo Isomet y se almacenaron en agua destilada por 24 horas a 37° C. La prueba de microtensión se realizó haciendo uso del Microtensile Tester (Bisco). Para el análisis estadístico se utilizaron las pruebas de Anova y Tukey (p=0.05).RESULTADOS: Los valores promedio de resistencia en los grupos experimentales fueron GI: ICem, 17.4 ± 4.94; GII: Panavia Automix, 17.5± 5.65; GIII: Relyx Ultimate, 17.2 ± 5.06 y en el Grupo Control: Maxcem fue 17.8 ± 4.48. No hubo diferencias estadísticamente significativas (p=0.974 - Prueba de Anova). Cuando se compararon los valores entre grupos, tampoco hubo diferencias (p>0.05).CONCLUSIONES: La resistencia de unión de los cementos resinosos autoadhesivos y el cemento resinoso dual universal es similar. (AU)

OBJECTIVE: To compare the strength of adhesion between self-adhesive resin cements and dual cement in the bovine enamel substrate.MATERIALS AND METHODS: Eight healthy bovine lower incisors divided into four groups were used. When dual resin cement group underwent a pretreatment of 37 % phosphoric acid and Universal Single Bond adhesive and 3 groups of self-adhesive resin cements underwent pretreatment with only 37 % phosphoric acid on enamel. Group I: ICem (Heraus Kulzer), Group II: Panavia Automix (Kuraray), Group III: Relyx Ultimate (3M-ESPE),GC: Maxcem Elite (Kerr). Specimens obtained (n = 30 per group) were obtained with a machine type Isomet and stored in distilled water for 24 hours at 37°C. The microtensile test was performed using of Microtensile Tester (Bisco). For statistical analysis, ANOVA and Tukey (p= 0.05) were used.RESULTS: The experimental groups showed, GI: ICem, 17.4 ± 4.94, GII: Panavia Automix, 17.5 ± 5.65, GIII: Relyx Ultima-te, 17.2 ± 5.06, and the control group GC: Maxcem Elite, 17.8 ± 4.48. Found no statistically significant difference (p=0.974 - Anova test). When the significance of microtensile resistance was compared between groups, there were no differences in any comparisons (p> 0.05).CONCLUSIONS: The bond strength of the self adhesive resin cement and dual universal resin cement show similar results. (AU)

Efecto del tiempo de grabado con ácido fosfórico al 37.5% sobre la superficie de esmalte haciendo uso de agentes cementantes autoadhesivos. Estudio in vitro / Effect of time to phosphoric acid etched 37.5%. On enamel surface of making use of self adhesive agents cementing. In vitro study

OBJETIVO: Comparar la resistencia traccional de resina compuesta adherida a la superficie del esmalte de bovino en diferentes intervalos de tiempos de 15 y 30 segundos haciendo uso de ácido grabador en tres agentes cementantes autoadhesivos y un grupo control. MATERIALES Y MÉTODOS: Fueron utilizados treinta y cinco incisivos inferiores sanos de bovino menor de 3 años, los cuales fueron divididos aleatoriamente en siete grupos correspondientes a cada cemento autoadhesivo y tiempo de grabado ácido: RelyX U200 (3M) (grupo U15") (grupo U30"), Bis Cem (BISCO)(grupo B15")(grupo B30"), MaxCem Elite (KERR)(grupo M15")(grupo M30"), RelyX Ultimate (3M)(grupo UL) se procedió a la cementación con los bloques de resina compuesta como se indica el protocolo previo grabado ácido del esmalte de 15 y 30 segundos para cada cemento . Los especímenes de 1 mm2 de área transversal (n = 30 por grupo) se almacenaron en agua destilada por 24 horas a 36 °C. La prueba de microtensión se realizó haciendo uso del Microtensile Tester (Bisco). Para el análisis estadístico se utilizaron las pruebas de Kruskal Wallis y U Mann Whitney (p<0.05). RESULTADOS: El grupo U 30" presentó una resistencia promedio de 24.82 (±3.80) MPa; el U 15", 23.40 (±5.80 ) MPa, el M30",30.86 (±9.85) MPa, el M15", 28.29 (±2.02) MPa, el B 30", 17.42(±3.49) MPa, el B15",17.63 (±3.61) MPa, y el UL, 31.53 (±6.39 ) MPa, encontrando diferencia significativa entre ellos (p < 0.001) a través del análisis de Kruskal Wallis . CONCLUSIÓN: El cemento Relyx Ultimate obtuvo el valor más alto de resistencia traccional encontrándose diferencias estadísticamente significativas con todos cementos autoadhesivos. No se encontraron diferencias estadísticamente significativas al comparar los dos tiempos de grabado ácido de 15 y 30 seg. en esmalte entre los grupos de cementos autoadhesivos, al cabo de 24 horas. (AU)

OBJECTIVE: To compare the tensile strength of composite resin bonded to the surface of bovine enamel in different time intervals of 15 to 30 seconds using etchant in three adhesive cementing agents and a control group. MATERIALS AND METHODS: The study involved thirty-five healthy lower incisors lower calf of three years, which were rando-mly divided into seven groups corresponding to each adhesive cement and time of etching: RelyX U200 (3M) (U15 group ") (group U30 "), Bis Cem (BISCO) (B15 group") (B30 group "), Maxcem Elite (KERR) (M15 group") (M30 group "), RelyX Ultimate (3M) (UL group) proceeded to cementing with blocks Composite protocol as the previous etching enamel 15 and 30 seconds for each indicated cement. Specimens 1 mm2 cross-sectional area (n = 30 per group) were stored in distilled water for 24 hours at 36 ° C. Microtensile test was performed using the Microtensile Tester (Bisco). For statistical analysis, Kruskal Wallis and Mann Whitney U (p <0.05) were used. RESULTS: U 30 "group had an average strength of 24.82 (± 3.80) MPa; U 15 ", 23.40 (± 5.80) MPa, the M30", 30.86 (± 9.85) MPa, the M15 ", 28.29 (± 2.02) MPa, the B 30", 17.42 (± 3.49) MPa, B15 " 17.63 (± 3.61) MPa, and UL, 31.53 (± 6.39) MPa, finding significant difference between them (p <0.001) through the analysis of Kruskal Wallis. CONCLUSION: The Ultimate Relyx cement had the highest value of tensile strength found statistically significant differences with all adhesive cements. No statistically significant when comparing the acid etching time of 15 to 30 sec differences. between enamel adhesive cements groups, after 24 hours. (AU)

Resistencia de unión entre dientes de bovino y cerámica feldespática utilizando tres cementos fotoactivados para carillas. Estudio in vitro / Ressitance of union between teeth of cattle and ceramic feldspathic using three for cement photoactivated veneers. In vitro Study

OBJETIVO: Comparar in vitro la resistencia de unión entre dientes de bovino y cerámica feldespática utilizando los cementos fotoactivados para carillas (Choisse II, Variolink N, Relyx Ultimate).MATERIALES Y MÉTODOS: El grupo de estudio estuvo conformado por 3 grupos; un grupo control y 2 grupos experimentales distribuidos aleatoriamente y determinados mediante la fórmula para comparar promedios; con 120 especímenes en total, n= 30 especímenes por grupo; se utilizaron tres agentes cementantes: Relyx Ultimate (3M ESPE), Choise II (BISCO), Variolink N (IVOCLAR). Con los agentes autoadhesivos se procedió a la cementación como indica el protocolo para cada cemento. Los especímenes de 1 mm2 de área transversal, se obtuvieron con una máquina de cortes tipo IsoMet y se almacenaron en agua destilada por 24 horas a 36 °C. La prueba de microtensión se realizó haciendo uso del Microtensile Tester (Bisco). Para el análisis estadístico se utilizaron las pruebas de ANOVA y Tukey (p=0.05). RESULTADOS: El grupo Variolink N presentó una resistencia promedio de 18.42 ± 3,40 MPa; el Relyx Ultimate 18.42 ± 5,32 MPa, y el Choise II 11.92 ± 4,32 MPa, encontrando diferencia significativa entre ellos (p < 0.001) a través del análisis de ANOVA. CONCLUSIÓN: No existe diferencia significativa ente los cementos Variolink N y Relyx Ultimate, pero ambos fueron superiores significativamente al cemento Choisse II al cabo de 24 horas. (AU)

PURPOSE: To compare in vitro the bond strength between bovine teeth and feldespathic ceramic cements photoactivated using veneers (Choisse II, Variolink N, Relyx Ultimate).MATERIALS AND METHODS: The study group consisted of 3 groups; a control group and two experimental groups randomly distributed and determined by the formula for comparing averages; 120 total specimens, specimens n = 30 per group; Relyx Ultimate (3M ESPE), Choise II (BISCO), Variolink N (IVOCLAR): Three cementing agents were used. With adhesive agents proceeded to cementing as indicated by the protocol for each cement. Specimens 1 mm2 cross-sectional area, obtained with a cutting machine Isomet type and stored in distilled water for 24 hours at 36 ° C. Microtensile test was performed using the Microtensile Tester (Bisco). For statistical analysis, ANOVA and Tukey (p = 0.05) were used.RESULTS: Group Variolink N provided an average of 18.42 ± 3.40 resistance MPa; The Ultimate Relyx 18.42 ± 5.32 MPa, and 11.92 ± 4.32 Choise II MPa, finding significant difference between them (p <0.001) through the ANOVA analysis.CONCLUSION: There is no significant difference being cements and Relyx Variolink® N Ultimate, but both were significant-ly higher cement Choisse II after 24 hours. (AU)

Efecto del acondicionamiento de la dentina con ácido poliacrílico al 15 % sobre la resistencia de unión de los cementos resinosos autoadhesivos / Effect of dentin conditioning with polyacrylic acid 15% on bond strenght of the self-adhesive resin cements

OBJETIVO: Evaluar el efecto del ácido poliacrílico al 15% (APA) aplicado por 10 y 20 segundos (s) en la dentina humana sobre la resistencia de unión de los cementos resinosos autoadhesivos. METODOLOGÍA: Se dividieron aleatoriamente veintisiete terceras molares en nueve grupos Maxcem Elite control (ME1), Maxcem Elite más APA aplicado por 10s (ME2), Maxcem Elite más APA por 20s (ME3), BisCem control (BC1), BisCem más APA por 10s (BC2), BisCem más APA por 20s (BC3), RelyX U200 control (RU1), RelyX U200 más APA por 10s (RU2), RelyX U200 más APA por 20s (RU3). Se cementaron discos de resina sobre la dentina y las muestras fueron almacenadas en agua destilada por 24h, luego se seccionaron para obtener microbarras de un área transversal de 1mm2 (n=30 por grupo). RESULTADOS: Los especímenes fueron evaluados con la prueba de microtensión. Los valores de la media y de la desviación estándar para cada grupo fueron: ME1=10.17MPa (±1.73), ME2=18.62 (±1.60), ME3=22.92 (±2.13), BC1=8.17 (±1.31), BC2=14.56 (±1.94), BC3=17.52 (±1.92), RU1=13.71 (±1.70), RU2=22.91 (±2.26) y RU3=30.42 (±1.50). Estos valores fueron analizados con las pruebas ANOVA de un factor y HDS de Tukey mostrando diferencias estadísticamente significativas (p<0.001) entre todos los grupos. CONCLUSIÓN: El acondicionamiento de la dentina con ácido poliacrílico al 15% incrementa significativamente la resistencia de unión de los cementos resinosos autoadhesivos, obteniéndose mejor resistencia en la aplicación por 20 segundos. (AU)

PURPOSE: To evaluate the effect of 15% polyacrylic acid (PAA) for 10 and 20 seconds applied to human dentin on the bond strength of three self-adhesive resin cements. MATERIALS AND METHODS: Twenty seven third molars were randomly divided into nine groups: Maxcem Elite control (ME1), Maxcem Elite + PAA applied for 10s (ME2), Maxcem Elite + PPA for 20s (ME3), BisCem control (BC1), BisCem + PAA for 10s (BC2), BisCem + PAA for 20s (BC3), RelyX U200 control (RU1), RelyX U200 + PAA for 10s (RU2), RelyX U200 + PPA for 20s (RU3). Resin disc were luted to dentin; after 24h of storage in distilled water, the samples were sectioned for obtaining microbar specimens whit a cross-sectional area of 1mm2 (n=30 per group). Specimens were submitted to the microtensile bond strength test. RESULTS: The mean and standard deviation result of each group were: ME1 = 10.17MPa (± 1.73), ME2 = 18.62 (± 1.60), ME3 = 22.92 (± 2.13), BC1 = 8.17 (± 1.31), BC2 = 14.56 (± 1.94), BC3 = 17.52 (± 1.92), RU1 = 13.71 (± 1.70), RU2 = 22.91 (± 2.26) and RU3 = 30.42 (± 1.50). These values were analyzed by one-way ANOVA and Tukey HDS shown statistically significant differences (p < 0.001) among all groups. CONCLUSION: Dentin conditioning with 15% polyacrylic acid significantly increases the bond strength of the self-adhesive resin cements, obtaining better resistance in the application for 20 seconds. (AU)

Rotura de bazo en dos tiempos / Two-Stages Splenic Rupture

El caso que traemos hoy a colación es el de un varón de 45 años de edad, que es encontrado muerto en su domicilio, refiriendo los vecinos que había sufrido una agresión 3 días antes. La inspección reveló algunas lesiones leves en la cabeza y los miembros, no mostrando el abdomen signos de violencia. La elasticidad de las paredes abdominales permite que la fuerza de un traumatismo se transmita rápidamente a los órganos internos. Esta misma laxitud sería la causa de la coexistencia de graves daños internos en ausencia de lesiones externas. En el caso de que haya cierto grado de anticipación pueden contraerse los músculos abdominales, con lo que se atenúan las lesiones. Las contusiones abdominales pueden ocasionar daños en los órganos internos de distinta índole. Destacan por su frecuencia las roturas hepáticas y en segundo lugar las esplénicas. Las lesiones abdominales en los traumatismos cerrados (sin comunicación entre la cavidad peritoneal y el exterior) pueden permanecer latentes varias horas, e incluso días, apareciendo de forma diferida los síntomas de irritación peritoneal (AU)

The case showed in this article is a forty five years old man who was founded dead at home suffering an aggression three days before, from what his neighbors told to police. Forensic inspection showed several head and limbs slight injuries without violence abdominal signs. Abdomen walls elasticity causes a fast traumatic force transmission to internal organs. This elasticity also explains serious internal injuries without external lesions. In case there exist certain anticipation, abdominal musculature contraction could lessen these injuries. Abdominal contusions could cause several damages types to internal organs. The most important are hepatic ruptures, and on the second place there are splenic ruptures. Abdominal injuries caused by closed traumatisms (without any connection between the peritoneal cavity andthe outside), could stay latent for many hours, even days, appearing peritoneal irritation delayed symptoms (AU)

Herida inciso-punzante y escápula alata: a propósito de un caso / Sharp injury and winged scapula: about a case

La peligrosidad de las heridas inciso-punzantes viene determinada por su situación y por la existencia de estructuras vitales subyacentes; alcanzando una mayor gravedad, las localizadas en tórax y cuello. Las lesiones cervicales adquieren un peor pronóstico vital cuando se afectan los grandes vasos o la vía aérea, pudiendo quedar secuelas incapacitantes por lesión de los nervios que discurren por la zona. En el siguiente artículo exponemos un caso de herida inciso-punzante laterocervical izquierda, con lesión (neurotmesis) del nervio accesorio o espinal (XI par craneal), que determina la aparición de una escápula alada, signo característico de esta lesión (AU)

The danger of incised wounds is determined by their position and the underlying vital structures, and the ones localized in the torax are more serius. Cervical lesions get worse vital pronostic when they affect great vessels and the airway. This could result in the disability of the nerves which flow in this area. In the next article, we present one left lateral-cervical incised wound case, with an accesory nerve (spinal accesory nerve or XI C.N.) disorder (neurotmesis), which determine the appearance of a winged scapula. The winged scapula is the characteristic sign of this lesion (AU)

Asfixia autoerótica: La escena de la muerte / Autoerotic asphyxia. The scene of the death

En números anteriores de nuestra revista se han tratado, con profusión de imágenes, las asfixias mecánicas; tanto en su aspecto macroscópico, como microscópico. Hoy mostramos una ahorcadura, atípica hasta hace escaso tiempo en nuestro medio, la "asfixia autoerótica". El diagnóstico de la naturaleza de la muerte (accidental, suicida e incluso homicida) ha sido muy discutido, teniendo un papel fundamental en su aclaración, la Diligencia de Levantamiento de Cadáver. Un examen meticuloso del lugar de los hechos nos va a orientar de manera definitiva sobre la naturaleza del óbito (AU)

In previous numbers of our magazine one has treated, with profusion of images, the asphyxiations mechanics; so much in their macroscopic aspect, as microscopic. Today we show a hanging, atypical up to scanty time ago in our way, the "autoerotic asphyxiation". The diagnosis of the nature of the death (accidental, suicidal and enclosed killer) has been very controversial, having a fundamental role in his explanation the scene of the death. A meticulous examination of the place of the facts is going to orientate us in a definitive way on the nature of the death (AU)

Antibiotic prescribing patterns and hospital admissions with respiratory and urinary tract infections.

OBJECTIVE: To explore the relationship between antibiotic prescribing indicators for assessing the prescribing quality of general practitioners (GPs) and populations' health outcome indicators. DESIGN: Descriptive cross-sectional study. SETTING: Aljarafe Primary Health Care Area (population 321,034) under the administrative jurisdiction of the Andalusian Public Health Care Service, Spain. In total, 162 GPs, representing 95.29% of the total number of GPs in the study area, were included in the analysis. METHODS: Antibiotic prescribing indicators based on clinical evidence and recommendations from local resistance patterns were chosen by the consensus group technique. Hospital admissions due to respiratory tract and urinary infections in the three hospitals of the study area were recorded. Multiple regression analysis was carried out to determine the relationship between community prescribing of antibiotics and hospital admissions due to serious complications from respiratory and urinary infections. RESULTS: The higher prescribing of antibiotics adjusted for patients and working days was associated with a significantly higher number of adjusted hospital admissions due complications arising from respiratory and urinary infections (p < 0.001) (R (2) = 0.142). This relationship was not found for indicators based on the relative prescribing of recommended first-line versus second and third-line antibiotics. There were fewer patients of women GPs admitted to hospitals (p = 0.021). CONCLUSIONS: Our findings show a statistically significant relationship-at the GPs level-between the quantitative antibiotic prescribing rate and standardized hospital admissions due to complications arising from respiratory and urinary infections of the assisted patients. Strategies should be addressed to reduce unnecessary antibiotic prescribing in primary care.

Development of NSAIDs prescription indicators based on health outcomes.

OBJECTIVE: To explore the relationship between prescribing indicators aimed at assessing the prescribing quality of general practitioners (GPs) and indicators of health outcomes at the population level. DESIGN: Ecological study. SETTING: Aljarafe Primary Health Care Area (population 321,034), part of the Andalusian Public Health Care Service, Spain. A total of 162 GPs, representing 95.29% of the total GPs in the study area, participated in the analysis. METHODS: The prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) was determined using evidence-based indicators chosen by the consensus group technique. Admissions to hospitals in the study area due to digestive ulcer, bleeding or perforation were recorded. Multivariate regression analysis was then carried out to determine both the amount of variation in hospital admissions that can be explained by a combination of prescribing indicators and the strength and direction of independent associations with individual indicators. RESULTS: The higher prescription of NSAIDs adjusted for patients and working days (p = 0.002) and the higher relative prescription of gastroprotective agents versus NSAIDs (p < 0.001) were associated with a higher number of adjusted hospital admissions due to gastrointestinal adverse events (coefficient of correlation R = 0.378). In addition, the higher number of prescriptions for analgesics than for NSAIDs was related to fewer admissions (p = 0.028). There were fewer patients of GPs with postgraduate training admitted to hospital for these complaints (p = 0.049). CONCLUSIONS: The risk of hospitalization for serious gastrointestinal adverse events can be partially linked to the prescribing of NSAIDs based on an analysis of the prescribing indicators. A higher prescribing of NSAIDs was associated with significantly higher admissions. This relationship was not found for indicators based on the relative use of some NSAIDs versus total NSAIDs or on the use of gastroprotective drugs.

Intoxicación por Monóxido de Carbono / Poisoning by carbon monoxide

Numerosos autores recomiendan la realización de análisis toxicológico, prácticamente en todos los casos forenses, especialmente, cuando tras el examen macroscópico no aparece suficientemente aclarada la causa de la muerte. La ausencia de lesiones patognomónicas en la mayoría de las intoxicaciones avalan la recomendación anterior; sin embargo, en algunos casos los hallazgos en la autopsia son indicativos del agente causal. Así vemos como la coloración rojo cereza de las livideces cadavéricas van a ser muy sugestivas de intoxicación por monóxido de carbono o cianuro

Several authors recommend to perform a toxicological analysis in practically every forensic autopsy, specifically when the macroscopical examination does not reveal sufficiently the cause of death. The absence of pathognomonic findings in the majority of poisonings support this recommendation. However; in some cases autopsy findings are indicative of the causative agent. For instance, the red cherry coloration from livor mortis are suggestive of a carbon monoxide or cyanide poisoning

Degüello homicida / Homicidal incised wounds of the throat

El degüello es la herida incisa que con más frecuencia provoca lesiones mortales; no obstante es la menos usual en nuestro medio. El mayor problema que plantea el degüello desde el punto de vista médico forense es el diagnóstico diferencial entre el homicidio y el suicidio. La dirección, profundidad, localización y el número de las heridas tienen gran importancia para ayudar a reconocer la etiología. En este número presentamos un caso de degüello homicida y se describen las lesiones más características que presentaba

Throat cut is the incise wound that most frequently causes mortal injuries; nevertheless is the less common in our means. The main problem of throat cut in forensic setting is de differential diagnosis between suicide and homicide. The direction, depth, site and number of the injuries have particular importance in helping us to recognize the ethiology. In this paper we present a case of homicidal incised wounds of the throat and the most characteristic injuries are described

Síndrome de Asfixia Sumersión / Asphyxia Drowning Syndrome

El hallazgo de un cadáver en el agua siempre nos plantea dudas diagnósticas: ¿Estamos ante un cadáver arrojado o caído al agua? ¿El sujeto ha fallecido por causas distintas a la sumersión, incluidas las de origen natural? ¿Se trata de una verdadera muerte por sumersión?. La utilización de exámenes complementarios en el diagnóstico de asfixia por sumersión ha sufrido diversos avatares. Las determinaciones bioquímicas han tropezado con los artefactos debidos a la putrefacción, lo que ha llevado a la aparición de determinados métodos de diagnóstico muy controvertidos. Además, los experimentos realizados en animales no siempre son extrapolables al ser humano, dado que hasta la cantidad de agua absorbida por vía aérea, parece ser mucho menor para estos últimos. El diagnóstico de muerte por sumersión se realizará, por lo tanto, estableciendo una correlación entre los hallazgos propios de la sumersión observados en la autopsia y las diferentes pruebas analíticas realizadas en el laboratorio

The finding of a corpse in water always raise doubts for a proper diagnosis: Are we before a corpse thrown or fallen into the water? Was the death due to causes different from drowning, including naturals?. It is a true death by drowning?. The use of complementary examinations in the diagnosis of drowning has undergone diverse ups and downs. The biochemical determinations have been confronted with the artefacts related to the putrefaction which has favoured the appearance of certain very controverted methods of diagnosis. In addition, the experiments made in animals not always must be applied to the human's beings, since the absorbed amount of water by air passages seems to be much smaller for the latest's. The diagnosis of death by drowning will be made, therefore, establishing a correlation between the typical findings of the submersion observed in the autopsy and the different complementary laboratory tests